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Here Comes Everybody--Are We Ready?

Posted By Gary Oftedahl, Monday, January 18, 2010
Updated: Thursday, June 9, 2011

In the chaotic environment of health care reform, the focus on health care coverage, improved outcomes, and the need for cost control have triggered a veritable onslaught of projects intended to support the transformation of what is an incredibly inefficient, often times ineffective system.

As if that wasn't enough, the evolving interest in advancing the medical/health care home concept as a method for moving toward patient centered care, and supporting primary care has created a barrage of efforts, focused on team building, patient engagement, community involvement, and improved outcomes in many aspects of health care. Many organizations, including CFHA, are heavily invested in the concept of collaborative care-integrating mental/behavioral health into the primary care/medical model which presently dominates the healthcare landscape. This has led to an increasing interest in improving the physician/provider-patient relationship.

But as I watch and participate in the efforts, I'm concerned that we may be doing nothing more than putting new wheels on a horse and buggy. There is much interest in taking a model which has conceptually been appealing for over 40 years, reconfiguring it a bit, and hoping that through paying differently we'll see a dramatic improvement. A key element in many of these efforts is the use of information technology as a key support in those efforts.

But I believe we need to think about technology in a different perspective, put a different lens on it than the traditional focus on an electronic health record, with increased capability for registry development and data retrieval. While that will be helpful, and provide much support, if that is our focus, we're only going to continue to fall behind the tsunami of technology which is overwhelming the world we live in.

Sadly, we struggle to even consider how the electronic health record will improve our care, failing to realize that most of these efforts are still tethered to organizations, controlled by the health care provider, non-portable, and to be honest, limited in their ability to truly meet our needs.

As we consider the role of technology in improving collaborative care, it is a question that actually applies to all aspects of our health care crisis. The august group of bloggers to follow will articulate much more eloquently than me the opportunities in various areas-hopefully challenging our assumptions and thinking.

From a high level, here are a few issues to consider. It is estimated that within 2-3 years we'll be using a form of technology on a regular basis that doesn't even exist today. If that's true, all our efforts on using a technology which is tethered in many respects seems doomed in attempts to create the solutions which will meet that new world-not even knowing what that will look like. Additionally, while many of us struggle with electronic health records, advanced personalized technology is exploding around us, and we as a health care industry are going to have to remove the blinders we wear and begin to think how do we use technology to meet our patients/citizens where they are, not expect them to meet us where we are. I'm a baby boomer, but even I know that there's a world out there-Facebook, social media, wiki approaches, smartphones, virtual communities, avatars, augmented reality-that will require us to think differently and use our skills and experience in a new way.

With the explosion of new technology, the access to information that was previously limited to an elite few, is now available immediately to most. Clay Shirky, in his provocative book, Here Comes Everybody, addresses the chaos that accompanies this dramatic change. One of my values as a physician used to come from having access to information that patients didn't. That's no longer true. As we move to patient centered care, engaging our patients and families in their health management, we will be forced to totally rethink the way we've done things in the past. How will smart phones revolutionize the management of chronic disease? What new technology will arise which provides even greater opportunity for personalizing information? What will medical records which are housed in a "cloud" and managed through a smartphone or perhaps a "health credit card" do in changing our approaches to supporting patients?

How do we use the virtual communities which are already arising around the world, and managing problems without including those entrenched in our present medical model? When do physicians as a content expert become a vestigial appendage no longer necessary to the delivery of over 80% of the health care needed? What will the skill sets and mind sets of those working in the health care arena need to look like to face the new world which will be defined in terms of virtual relationships, instantaneous connectivity, immediate feedback, and new opportunities we yet aren't even aware of?

I'm hoping those who follow me will have the answers, or at least some provocative suggestions. For me, as I struggle to contemplate the iPhone in my hand, I see technology as a great opportunity to transform the health care system, but also a great challenge to us. It will require the shifting of existing paradigms that will cause great angst, chaos, and resistance, but will be essential if we are to be relevant in the future. Sounds exciting to me, let's get going.

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CFHA is a member-based, 501(c)(3) non-profit organization dedicated to making integrated behavioral and physical health the standard of care nationally. CFHA achieves this by organizing the integrated care community, providing expert technical assistance and producing educational content.